本文關(guān)鍵詞：高血壓病患者血清TLR4和HMW-ADP的水平變化與臨床意義研究　出處：《江蘇大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 原發(fā)性高血壓 Toll樣受體4 高分子量脂聯(lián)素 炎癥 血壓

【摘要】：目的:研究高血壓病患者血清Toll樣受體4(toll-like receptor 4,TLR4)及其相關(guān)炎癥因子與脂肪因子高分子量脂聯(lián)素(high molecular weight adiponectin,HMW-ADP)的表達(dá),并探討其與血壓水平、靶器官損害的關(guān)系及對降壓療效的影響。方法:入選新診斷為原發(fā)性高血壓1級、2級和3級的住院患者共150例(按血壓水平分為3組,每組50例),同時(shí)入選50例血壓正常者作為對照組。于應(yīng)用降壓藥物前空腹抽取研究對象外周靜脈血,采用酶聯(lián)免疫吸附法(ELISA)分別檢測血清TLR4及相關(guān)炎癥因子C-反應(yīng)蛋白(CRP)、白細(xì)胞介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)和脂肪因子HMW-ADP的表達(dá)。6個(gè)月后門診隨訪患者血壓控制情況。采用Pearson相關(guān)性分析研究高血壓病患者TLR4與HMW-ADP之間的相關(guān)性;分別應(yīng)用多元線性回歸和logistic回歸分析TLR4及相關(guān)炎癥因子和HMW-ADP與血壓水平、靶器官損害的關(guān)系;采用多元線性回歸研究高血壓病患者血清TLR4、HMW-ADP初始水平對6個(gè)月后降壓療效的影響。結(jié)果:(1)高血壓病1級、2級和3級組患者血清TLR4的表達(dá)水平分別為(14.51±4.37)ng/m L、(23.57±6.05)ng/m L和(36.41±7.68)ng/m L,與正常組[(7.77±3.24)ng/m L]相比,差異有顯著性(均P0.01)。血清CRP在高血壓病1級、2級和3級組的含量分別是(4.50±1.23)mg/L、(6.19±1.00)mg/L和(8.69±1.53)mg/L,與正常組(3.71±1.59)mg/L相比,差異有顯著性(均P0.01)。在高血壓病1級、2級和3級組中IL-6的表達(dá)水平分別是(6.94±1.30)ng/L、(8.66±1.35)ng/L和(11.88±1.11)ng/L,與正常組[(3.77±0.85)ng/L]相比,差異有顯著性(均P0.01)。TNF-α在高血壓病1級、2級和3級組的含量分別是(47.00±5.46)ng/L、(55.19±9.75)ng/L和(69.08±8.83)ng/L,與正常組[(37.39±3.65)ng/L]相比,差異有顯著性(均P0.01)。(2)血清HMW-ADP水平在高血壓病1級、2級和3級組患者分別為(7.48±1.33)mg/L、(5.48±1.21)mg/L和(3.44±1.04)mg/L,與正常組[(11.36±3.20)mg/L]相比,差異有顯著性(均P0.01)。(3)Pearson相關(guān)性分析顯示,在所有研究對象,血清TLR4與HMW-ADP表達(dá)水平呈負(fù)相關(guān)(r值為-0.782,P0.05),與C-反應(yīng)蛋白(CRP)及體質(zhì)量指數(shù)(BMI)呈正相關(guān)(r值分別為0.747、0.721,均P0.05)。(4)多元回歸分析及l(fā)ogistic回歸分析顯示,在高血壓患者,血清TLR4和HMW-ADP均為平均動(dòng)脈壓(B值分別為0.408與-2.51,均P0.01)和靶器官損害的獨(dú)立影響因素(OR分別為1.335與0.717,均P0.05)。血清TLR4/HMWADP比值預(yù)測靶器官損害及臨床狀況的ROC曲線下面積為0.95,高于單獨(dú)TLR4的曲線下面積0.88及HMW-ADP的曲線下面積0.83(均P0.05)。(5)多元回歸分析顯示,對于6個(gè)月后的血壓控制水平,TLR4是不同降壓藥物治療患者唯一公共的影響因素(P≤0.01)。結(jié)論:1.在高血壓病患者,血清TLR4和HMW-ADP表達(dá)量與血壓水平及靶器官損害密切相關(guān),其中TLR4介導(dǎo)的炎癥是血壓升高及靶器官損害的促進(jìn)因素,而HMW-ADP是保護(hù)因素。2.高血壓病患者血清TLR4初始水平影響隨訪6個(gè)月時(shí)的降壓效果。
[Abstract]:Objective: to study the serum Toll like receptor 4 toll-like receptor 4 in patients with hypertension. TLR4), its related inflammatory factors and adiponectin, high molecular weight adiponectin (molecular weight adiponectin). To investigate the relationship between HMW-ADP and blood pressure level, target organ damage and antihypertensive effect. There were 150 inpatients of grade 2 and grade 3 (50 cases in each group according to blood pressure level). At the same time, 50 patients with normal blood pressure were selected as the control group. The subjects' peripheral venous blood was drawn on an empty stomach before the use of antihypertensive drugs. Elisa was used to detect serum TLR4 and related inflammatory factor C- reactive protein (CRP) and interleukin-6 (IL-6). Tumor necrosis factor- 偽 (TNF- 偽). Blood pressure control in outpatient follow-up patients after 6 months. Pearson correlation analysis was used to study the relationship between TLR4 and HMW-ADP in patients with hypertension. Relevance; Multivariate linear regression and logistic regression were used to analyze the relationship between TLR4, related inflammatory factors and HMW-ADP with blood pressure level and target organ damage. Multivariate linear regression was used to study the effect of the initial serum TLR4 HMW-ADP level on the hypotensive effect after 6 months. The level of serum TLR4 expression in grade 2 and grade 3 patients was 14.51 鹵4.37 ng / mL, respectively. 23.57 鹵6.05 ng / mL and 36.41 鹵7.68 ng / mL, respectively, and normal group. [Compared with 7.77 鹵3.24 ng / mL, the difference was significant (all P 0.01). Serum CRP was in grade 1 of hypertension. The contents of grade 2 and grade 3 were 4.50 鹵1.23 mg / L and 8.69 鹵1.53 mg / L, respectively. There was a significant difference compared with the normal group (3.71 鹵1.59 mg / L) (all P 0.01) in grade 1 of hypertension. The expression levels of IL-6 in grade 2 and grade 3 were 6.94 鹵1.30 ng / L and 11.88 鹵1.11 ng / L, respectively. Normal group. [Compared with 3.77 鹵0.85 ng / L, there was a significant difference (all P 0.01). TNF- 偽 was in grade 1 of hypertension. The contents of grade 2 and grade 3 were 47.00 鹵5.46 ng / L, 55.19 鹵9.75 ng / L and 69.08 鹵8.83 ng / L, respectively. [There was a significant difference in serum HMW-ADP level in grade 1 of hypertension (P 0.01g / L, P < 0.01), compared with 37.39 鹵3.65 ng / L (P < 0.05). Grade 2 and grade 3 patients were 7.48 鹵1.33 mg / L and 5.48 鹵1.21 mg / L, respectively, and 3.44 鹵1.04 mg / L, respectively, as compared with the normal group. [Compared with 11.36 鹵3.20 mg / L, there was a significant difference (all P 0.01). Pearson correlation analysis showed that there were significant differences in all the subjects. There was a negative correlation between serum TLR4 and HMW-ADP expression (r = -0.782, P 0.05). There was a positive correlation between CRP and BMIand CRP and BMI. the r values were 0.721 and 0.721, respectively. Multiple regression analysis and logistic regression analysis showed that in patients with hypertension. The mean arterial pressure B values of serum TLR4 and HMW-ADP were 0.408 and -2.51, respectively. The OR of the independent influencing factors of target organ damage were 1.335 and 0.717, respectively. The area under the ROC curve for predicting target organ damage and clinical status was 0.95. Multiple regression analysis showed that the area under the curve was 0. 88 higher than that of TLR4 alone and the area under the curve of HMW-ADP was 0. 83 (all P 0. 05). TLR4 was the only common influencing factor in patients with different antihypertensive drugs after 6 months. Conclusion: 1. In hypertensive patients, TLR4 is the only common influencing factor for blood pressure control after 6 months. Conclusion: TLR4 is the only common factor in patients with different antihypertensive drugs (P 鈮，

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